Search state statutes and regulations in all 50 states and the District of Columbia to find out what rights you have in your state and what other states are doing to empower physicians and patients in the face of health insurer market power.
Definitions; Network adequacy; Notice of nonrenewal or termination; Transition of services; Network transparency
Findings—Intent—2019 c 427; Short title; Definitions; Dispute resolution process—Determination of commercially reasonable payment amount; Requirement to provide certain information on website or upon consumer request—Requirement to provide carriers with nonemployed provider lists; Health care provider—Requirement to provide certain information on website or upon consumer request—Requirement to submit network status information to carriers; Carrier—Requirement to update website and provider directory—Requirement to provide enrollee with certain information; Application of chapter to self-funded group health plans that elect to participate in balance billing protection provisions—Annual notice to commissioner; Determining the adequacy of provider networks—Required considerations; Allowed amounts paid to nonparticipating providers; Application of state and federal requirements—Applicability information access—Waivers prohibited
Definitions; Network Adequacy Standards; Filing and Content of Access Plan; Travel Distance Standards; Appointment Waiting Time Standards; Provider-to-Enrollee Ratio Standards; Telehealth; Waiver Request Standards; Confidential Information in Access Plans
Purpose and Scope; Applicability; Definitions; Filing Procedures; Material Changes to a Network; Provider Directory Audits; Notice of Nonrenewal or Termination; Confidentiality
Network Adequacy
Network Adequacy; Directories
General; Definitions; Network Adequacy Standards; Network Access Plan Standards; Coordination and Continuity of Care; Network Access Plan Disclosures; Attestations; Provider Directories
Title; Applicability; Application to health benefit plans under the Employee Retirement Income Security Act of 1974; Payment for emergency medical services; Payment for nonemergency medical services; Restriction prohibited; Covered person’s financial responsibility; All-payer health claims data base; Request for arbitration; When requests for arbitration must be dismissed; Insurer’s obligation to provide information; Penalties for a provider’s failure to timely provide requested data to the Commissioner; Rules; opportunity to settle; referral to resolution organization; Selection of arbitrator; Arbitration filings; Arbitrator’s decision; Payment; Referral to governing authority; When lawsuits are prohibited; Reports by resolution organizations; Commissioner reports; Georgia Administrative Procedure Act; Reporting to credit reporting agency prohibited; Network adequacy requirements; Insurer annual report and Commissioner’s determination of compliance; Monetary penalties.
Factor-Based Evidence of Compliance with Network Adequacy Requirements
Purpose; Authority; Applicability and Scope; Affordable Care Act; Definitions; Quality Assurance Standards; Access to Services; Adverse Health Care Treatment Decisions; Grievance Register and Grievance Procedures; Reporting Requirements; Effective Date